THURSDAY EVENING - PURIM FEAST RESERVATION FORM Family Name: First Names: Address: City: State: Zip Code: Phone: Email:* Adults 00 01 02 03 04 05 06 07 08 09 10 Children 00 01 02 03 04 05 06 07 08 09 10 Cost: (with advance reservations) $36 per Adult $18 per Child I would like to be an event sponsor ($360.00) Please charge a total of $ to my credit card. Credit Card Type: Visa Master Card American Express Credit Card Number: Exp.(mm/yyyy) 01 02 03 04 05 06 07 08 09 10 11 12 / 2019 2020 2021 2022 2023 2024 2025 2026 My check payable to Chabad of Parkland is in the mail. Please mail all checks to Chabad of Parkland - 7170 Loxahatchee Rd. Parkland, FL. 33067 Thank you so much!... We look forward to you JOINING US! For any questions, please contact us: 954-970-9551 This page uses 128 bit SSL encryption to keep your data secure.